Provider Demographics
NPI:1952654881
Name:TETON FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:TETON FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:208-528-6225
Mailing Address - Street 1:3345 S HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7981
Mailing Address - Country:US
Mailing Address - Phone:208-525-6225
Mailing Address - Fax:208-528-8022
Practice Address - Street 1:3345 S HOLMES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7981
Practice Address - Country:US
Practice Address - Phone:208-525-6225
Practice Address - Fax:208-528-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1952654881Medicaid
ID6720040001Medicare NSC
ID1952654881Medicaid
ID20002425Medicare PIN